Mann-Whitney Rank Sum Test Research Articles

Safety and Efficacy of the Prostar XL Vascular Closing Device for Percutaneous Closure of Large Arterial Access Sites

Purpose. The purpose of this study is to retrospectively evaluate the efficacy and safety of the Prostar XL device for percutaneous large access site closure in an unselected patient and operator collective. Materials and Methods. All patients (n = 50) who had received percutaneous vascular closing with the Prostar XL device in our institution with follow-up data of at least 6 months were retrospectively included. Primary (freedom from surgical conversion) and continued (freedom from groin surgery in further course) technical success and major (deviations from expected outcome requiring surgery) and minor (other deviations from expected outcome) complications were assessed. Success and complications rates were correlated with delivery system size (Mann-Whitney Rank Sum Tests) and operator experience (paired samples t-test). Results. Rates of primary and continued technical success as well as major and minor complications were 93.6%, 89.7%, 10.3%, and 10.3% (groin based) and 90.0%, 84.0%, 16.0%, and 16.0% (patient based), respectively. No correlation of success and complications rate was found with delivery system sizes and operator experience. Conclusions. Application of the Prostar XL device for percutaneous closure of large arterial access sites is safe with a relatively high rate of technical success and low rate of major complications. Sizes of the delivery systems and the experience of the operator did not influence the results.

154 EMBRYO RESPONSE OF SUPEROVULATED HOLSTEIN HEIFERS INSEMINATED WITH X-SORTED FROZEN SPERM

A study was conducted within a commercial embryo transfer program to assess the appropriateness of X-sorted semen in superovulated heifers. Commercial X-sorted semen frozen at a dose of 2 million sperm/straw and unsorted semen frozen at a dose of 20 to 30 million sperm/straw was used in donors according to the owner’s genetic criteria. One-hundred 15- to 18-month-old Holstein heifers were superovulated as follows: Animals received a CIDR device (Pfizer Animal Health, New York, NY, USA) for 13 days. At the time of CIDR insertion and 5 days later, heifers received 2 mL (0.15 mg) of d-cloprostenol (Veteglan, Laboratorios Calier, Spain). Gonadotropin-releasing hormone (GnRH), 200 mcg IM (Gonasyl, SIVA, Spain) was administered twice, 36 hours after the second prostaglandin (PGF) and 24 hours after CIDR removal. Superovulatory treatments with commercial FSH (Pluset, Laboratorios Calier) were initiated 36 hours after the first GnRH, with a total dose of 11.5 mL (575 IU), given twice daily in 10 daily decreasing-dose injections. Luteolysis was induced with 0.15 mg PGF given twice, 12 h before and at the time of CIDR removal. Heifers were randomly assigned to two groups for insemination in the uterine body: Group A (n = 31) heifers were inseminated with 5 straws of X-sorted semen in three inseminations (2 straws at 12 h, 2 straws at 18 h, and 1 straw at 24 h after the last GnRH); Group B (n = 69) heifers were inseminated twice with unsorted semen (one straw at each of 12 and 24 h after the last GnRH). A total of 614 embryos (153 in Group A and 461 in Group B) were collected and frozen. There were no significant differences between groups (Mann–Whitney rank sum test, SigmaStat, Systat Software Inc., San Jose, CA, USA) in the embryo production obtained (Table 1). Eighty-four embryos frozen with ethylene glycol were thawed and transferred; 34 from Group A, where all births were females and 50 from Group B with a 0.54 sex ratio. Pregnancy rates were 55 and 54% in Groups A and B, respectively. In conclusion, with the superovulation and AI schedule utilized in this experiment, the use of X-sorted semen in heifers can achieve reproductive outcomes similar to those obtained with unsexed semen, with the benefit of an increase in females offspring. Table 1.Mean number of recovered ova/embryos, transferable embryos, and unfertilized ova obtained in superovulated Holstein heifers inseminated with X-sorted (Group A) and unsorted (Group B) semen

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Introduction: Thrombus formation has been linked to adverse outcomes following the Fontan operation. No data exist to describe the effect of warfarin on INR values when the drug is initiated during the early post-operative (PO) period. Hypothesis: Patients will be more likely to achieve a supratherapeutic (ST) INR if their baseline INR was > 1.3 or if warfarin was started early in the PO period. Methods: This retrospective study describes the incidence of ST (> 2.5) INR values after the Fontan procedure at our institution between April, 2009 and January, 2012. Patients met inclusion criteria if the surgical procedure involved the initial conversion to a Fontan circuit and were initiated on warfarin during the immediate PO hospital stay. Excluded patients were those without a documented INR within 24 hours before warfarin initiation or those with < 2 INR values after initiating therapy. Data were analyzed with the Fisher’s exact test, Student’s t-test or Mann-Whitney Rank Sum test, as appropriate. Statistical significance was taken at p < 0.05. Results: A total of 32 patients met inclusion criteria: female (59.4%), systemic right ventricle (61.3%), under 3 y of age (81.3%), lateral caval tunnel Fontan (96.9%), with fenestration (93.8%). The median length of stay was 10 days. ST INR values after warfarin initiation occurred in 12.5 % of patients with an additional 6.3 % requiring dose adjustments due to a rapidly increasing INR. Patients with a ST INR were started on warfarin earlier compared to those in the non-ST group (POD 5 vs POD 2, p=0.037, respectively). Baseline INR values or initial warfarin doses were not significantly different between the groups. There were no reported thrombi or thromboembolic events and the only clinically significant bleeding event occurred while the INR value was subtherapeutic. Conclusions: Patients undergoing the Fontan procedure may require lower doses to achieve similar target INR values when warfarin is initiated closer to the surgical procedure date. Despite this observation, warfarin appears to be a safe agent in the early Fontan PO period when INR is monitored closely. One should use caution and consider dose reduction when initiating warfarin before PO day 3 after a Fontan operation.

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Introduction: An association was recently reported between in-ICU mild-to-moderate hypoglycemia (MH) and hospital mortality (M), with inconsistent association between M & the number of hypoglycemic events (MHE). However, the impact of MH on survivors’ morbidity and associated changes in their disposition at hospital discharge is unknown. Hypothesis: MH does not affect routine home discharge (H) of survivors of critical illness. Methods: We studied a retrospective cohort of patients in a Med/Surg ICU, requiring IV insulin infusion, targeting blood glucose (BG) 90-130 mg/dl, using computer-guided insulin dosing (CG) [GlucoStabilizer™] between 3/1/08-6/30/09. Exclusions were age <18 yrs, <10 BG values, minimal BG <41 mg/dl, ICU LOS <24 h, diabetic ketoacidosis/hyperglycemic hyperosmolar state, hospital readmission, & in-hospital mortality. MH was defined as BG 41-70 mg/dl. We examined rates of H across strata of minimal MH, MH between patients with and without H, and determinants of H. Chi-square test for trend, Mann-Whitney rank-sum test, and stepwise multivariate regression modeling were used, as appropriate. Results: Three hundred twenty nine patients met study criteria (overall M 18.2%). Patients had mean (SD) age 58.3 (15.5) yrs; 57% were male; 43% Hispanic; 57% had diabetes; median (IQR) ICU LOS 4.8 (2.7-9.2) days; mean (SD) of patients’ average BG 125.5 (24.9) mg/dl. One or more MHE occurred in 48% of patients (>2 MHE in 42% of MH patients). H was lower in patients with MH (OR = 0.37 [95% CI 0.24-0.58; p <0.0001]) and tended to be lower within decreasing 10 mg/dl strata of MH (p = 0.055). Minimal BG was higher in H vs. non-H patients (75 vs. 66 mg/dl, respectively; p <0.0001). The number of MHE, but not MH, was a predictor of H on multivariate analysis (OR 0.84 per event [95% CI 0.74-0.96; p = 0.009]. Conclusions: MH was associated with reduced rates of H in the present cohort. However, this adverse association was likely mediated by recurrence of MHE, which was a negative predictor of H. The generalizability of these findings needs further examination in other patient populations, CGs, and glycemic targets.

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Introduction: In-ICU glycemic variability (GV) is associated with increased mortality (M). However, its effect on survivors’ morbidity and associated changes in disposition at hospital discharge is unknown. Hypothesis: Increasing GV reduces rates of home discharge among survivors of critical illness. Methods: We studied a retrospective patient cohort in a Med/Surg ICU, requiring insulin infusion, targeting blood glucose (BG) 90-130 mg/dl, using computer-guided insulin dosing (CG) [GlucoStabilizer™] between 3/1/08-6/30/09. Exclusions were age <18 yrs, <10 BG values, diabetic ketoacidosis/hyperglycemic hyperosmolar state, hospital readmission, & in-hospital mortality. GV was defined as standard deviation of the means of each patient’s BG (BGave). We examined rates of routine home discharge (H) across GV quartiles, between patients with and without H, and determinants of H. Chi-square test for trend, Mann-Whitney rank-sum test, and stepwise multivariate regression modeling were used, as appropriate. Results: Three hundred forty one patients met study criteria (overall M 19.9%). Patients had mean (SD) age 58.3 (15.4) yrs; 56% were male; 42% Hispanic; 57% had diabetes; median (IQR) ICU LOS was 4.8 (2.8-9.3) days; mean (SD) BGave 125.2 (24.5) mg/dl. Median (IQR) GV was 31.3 (24.9-47.6) mg/dl. Rates of H increased with GV quartile (p = 0.0018). The OR for H among survivors in the highest vs. lowest GV quartiles was 2.8 (95% CI 1.5-5.2; p = 0.0011). GV was higher in patients with H than non-H (36.1 vs. 30.0 mg/dl, respectively; p = 0.002). Finally, GV was not a predictor of H on multivariate analysis. Conclusions: Contrary to expectations, GV was directly associated with home discharge among survivors of critical illness in the present cohort. The odds of routine home discharge were 280% higher among patients in the highest vs. lowest GV quartiles, suggesting lower residual morbidity in the former. The generalizability of these findings needs further examination in other patient populations, CGs, and glycemic targets.

Epigenetic Regulation of Galectin-3 Expression by β1 Integrins Promotes Cell Adhesion and Migration

Introduction of the integrin β1- but not the β3-subunit in GE11 cells induces an epithelial-to-mesenchymal-transition (EMT)-like phenomenon that is characterized by the loss of cell-cell contacts, cell scattering, increased cell migration and RhoA activity, and fibronectin fibrillogenesis. Because galactose-binding lectins (galectins) have been implicated in these phenomena, we investigated whether galectins are involved in the β1-induced phenotype. We examined 9 galectins and, intriguingly, found that the expression of galectin-3 (Gal-3) is specifically induced by β1 but not by β3. Using β1-β3 chimeric integrins, we show that the induction of Gal-3 expression requires the hypervariable region in the extracellular domain of β1, but not its cytoplasmic tail. Furthermore, Gal-3 expression does not depend on RhoA signaling, serum factors, or any of the major signal transduction pathways involving protein kinase C (PKC), p38 mitogen-activated protein kinase (p38MAPK), extracellular signal-regulated kinase-1/-2 (ERK-1/2), phosphatidylinositol-3-OH kinase (PI3-K), or Src kinases. Instead, Gal-3 expression is controlled in an epigenetic manner. Whereas DNA methylation of the Lgals3 promoter maintains Gal-3 silencing in GE11 cells, expression of β1 causes its demethylation, leading to transcriptional activation of the Lgals3 gene. In turn, Gal-3 expression enhances β1 integrin-mediated cell adhesion to fibronectin (FN) and laminin (LN), as well as cell migration. Gal-3 also promotes β1-mediated cell adhesion to LN and Collagen-1 (Col)-1 in cells that endogenously express Gal-3 and β1 integrins. In conclusion, we identify a functional feedback-loop between β1 integrins and Gal-3 that involves the epigenetic induction of Gal-3 expression during integrin-induced EMT and cell scattering.

A two-stage approach using Gaussian mixture models and higher-order statistics for a classification of normal and pathological voices

A two-stage classifier is used to improve the classification performance between normal and pathological voices. A primary classification between normal and pathological voices is achieved by the Gaussian mixture model (GMM) log-likelihood scores. For samples that do not meet the thresholds for normal or disordered voice in the GMM, the final decision is made by a higher-order statistics (HOS)-based parameter. The normalized skewness and kurtosis, and means of the normalized skewness and kurtosis were estimated using a sustained vowel /a/ from 53 normal and 173 pathological voices taken from the Disordered Voice Database. Mel-frequency cepstral coefficients (MFCC)-based GMM, the HOS methods, and a two-stage classifier based on the GMM-HOS were performed for each voice signal. A Mann–Whitney rank sum test was used to detect differences in the means of the HOS-based parameters. A fivefold cross-validation scheme was performed to test the classification method. When 16 Gaussian mixtures were used, the MFCC-based GMM algorithm is performed with 92.0% accuracy. When means of the normalized skewness and kurtosis were used, performances of 82.31 and 83.67% were obtained, respectively. The two-stage classifier with 16 Gaussian mixtures and the mean of the normalized kurtosis classified samples with a 96.96% accuracy were obtained. The proposed two-stage classifier is more accurate than the MFCC-based GMM and HOS methods alone and shows potential for the classification of voices in the clinic.

The influence of HLA supertype on thymidine analogue associated with low peripheral fat in HIV

To examine the relationship between human leukocyte antigen (HLA) genotype and body composition changes induced by thymidine analogue nucleoside reverse transcriptase inhibitor (NtRTI) use in HIV-positive individuals. Data collected during the Simplification with Tenofovir-Emtricitabine (TDF-FTC) or Abacavir-Lamivudine (ABC-3TC) (STEAL) study were analysed to examine the potential association of HLA genotypes with changes in body composition in treatment-experienced HIV-positive individuals. Demographic, HIV-related, body composition and HLA genotyping data from the STEAL study were used in this analysis. The mean percentage peripheral fat at study baseline was compared in participants with and without prior NtRTI use. Analyses were also carried out for each HLA supertype strata, for five HLA genes, within the thymidine-exposed group. These comparisons were made using Mann-Whitney rank-sum tests. Participants with prior NtRTI use had a significantly lower baseline mean peripheral fat percentage compared to those without NtRTI use (31.9 vs. 34.7%; P = 0.0045). However, participants carrying one or more of the three particular HLA supertype alleles, A01, B08 and DQ2, showed no significant difference in mean peripheral fat percentage at baseline by NtRTI use. Among participants with prior NtRTI exposure, there were significant differences in mean peripheral fat by HLA A01, B08 and DQ2 allele expression compared to those without expression of these alleles (A01: 34.91% vs. no A01: 30.3%; P = 0.0087; B08: 36.2% vs. no B08: 31.1%; P = 0.0317; DQ2: 35.16% vs. no DQ2: 30.06%; P = 0.0081). This analysis suggests that HIV-infected individuals carrying HLA A01, B08 or DQ2 supertype alleles may be resistant to NtRTI-induced peripheral fat loss.

Use of a wireless, inertial sensor‐based system to objectively evaluate flexion tests in the horse

A wireless, inertial sensor-based system has previously been validated for evaluation of equine lameness. However, threshold values have not been determined for the assessment of responses to flexion tests. The aim of this investigation was to evaluate a sensor-based system for objective assessment of the response to flexion. Healthy adult horses (n = 17) in work were recruited prospectively. Horses were instrumented with sensors on the head (accelerometer), pelvis (accelerometer) and right forelimb (gyroscope), before trotting in a straight line (minimum 25 strides) for 2 consecutive trials. Sensors measured 1) vertical pelvic movement asymmetry (PMA) for both right and left hindlimb strides and 2) average difference in maximum and minimum pelvic height (PDMax and PDMin) between right and left hindlimb strides in millimetres. A hindlimb was randomly selected for proximal flexion (60 s), after which the horse trotted a minimum of 10 strides. Response to flexion was blindly assessed as negative or positive by an experienced observer. Changes in PMA, PDMax and PDMin between baseline and flexion examinations were calculated for each test. Statistical analysis consisted of a Pearson's product moment test and linear regression on baseline trials, Mann-Whitney rank sum test for effect of flexion and receiver operator curve (ROC) analysis of test parameters. There was a strong correlation between trials for PMA, PDMin and PDMax measurements (P < 0.001). A positive flexion test resulted in a significant increase in PMA (P = 0.021) and PDMax (P = 0.05) only. Receiver-operator curve analysis established cut-off values for change in PMA and PDMax of 0.068 and 4.47 mm, respectively (sensitivity = 0.71, specificity = 0.65) to indicate a positive response to flexion. A positive response to flexion resulted in significant changes to objective measurements of pelvic symmetry. Findings support the use of inertial sensor systems to objectively assess response to flexion tests. Further investigation is warranted to establish cut-off values for objective assessment of other diagnostic procedures.

Abstract 18753: ST Elevation Myocardial Infarction in Hospitalized Patients is Associated with Delayed Recognition, Low Rate of Early Revascularization and High Mortality

Background ---- Efforts to improve the management of ST segment elevation myocardial infarction (STEMI) have focused on patients whose symptoms begin outside of the hospital. Relatively little is known about STEMI that occurs in patients hospitalized for another condition. Methods ---- In-patient STEMI at a university hospital with primary percutaneous coronary intervention (PCI) center were identified by searching the Discharge Database and Cardiac Catheterization Laboratory Database. The diagnosis of STEMI was confirmed by two cardiologists. Non-normally distributed data are presented as median [25%,75%]. Comparison between groups was done using Mann-Whitney rank sum test for continuous variables and χ 2 for categorical variables. Results - A total of 48 in-patient STEMI cases were identified from 139,410 adult discharges from 2007 to 2011. In comparison with 184 out-patient STEMIs who presented directly to the same hospital during the same time span, in-patient STEMI patients were older (69 ± 13 vs 60 ± 13 years; p &lt; 0.01) and more often female (50% vs 33%; p &lt; 0.01). Symptoms were the reason for the index ECG more often in outpatient STEMIs (99% vs 33%; p &lt; 0.01); for in-patient STEMIs a change in clinical status (60%) and/or changes on telemetry (7%) also precipitated an ECG. The median time between the onset of symptoms or change in clinical status to ECG for in-patient STEMI was much greater than door to ECG time for outpatient STEMI (30 [10, 600] vs 5 [2, 10] minutes; p &lt; 0.001). Coronary angiography (71% vs 97%; p &lt; 0.01) and PCI (56% vs 95%; p &lt; 0.01) were performed less frequently in in-patient STEMI. The median ECG to angiography time (91 [45,197] vs. 34 [24,47] minutes; p &lt; 0.001) and the ECG to first device activation (129 [65,250] vs. 51 [40,70] minutes; p &lt; 0.001) were longer with in-patient STEMI. The in-hospital mortality for the in-patient STEMI group was 39.6% but revascularization within 3 hours from the onset of STEMI related event was associated with lower in-hospital mortality compared to patients who had delayed or no revascularization (15% vs 50%; p = 0.02). Conclusion ---- In-hospital STEMI is associated with atypical clinical presentation, delayed ECG interpretation, low rate of rapid revascularization and high mortality.

MCL-1 and Mir-181c in GATA2 Mutation Associated Monomac and Familial Myelodysplastic Syndrome

AbstractAbstract 3807 Background:Somatic and germline mutations in GATA2 were recently identified in patients diagnosed with MonoMAC, the hallmarks of which include mono cytopenia, B-cell and NK-cell lymphopenia, susceptibility to opportunistic infections (e.g. MAC), and a strong propensity to develop hypocellular MDS/AML or CMML. GATA2 mutations were also recently identified in other related disorders: Emberger syndrome (primary lymphedema with myelodysplasia), Familial MDS/AML, and DCML (Dendritic Cell, Monocytes, Lymphoid Deficiency). Family members with GATA2 mutations show variable penetrance and expressivity indicating that other factors may be required for development of disease and phenotype. GATA2 mutations are thought to result in loss of function or haploinsufficiency, but the precise mechanism for the development of cytopenias, immunodeficiency, and susceptibility to MDS remains to be elucidated. MicroRNA (miR) represents a unique mechanism of post-transcriptional gene regulation. In this study we generated microRNA profiles of patient derived MonoMAC cell lines followed by functional studies to identify aberrant miRs and their targets, which could potentially cooperate with GATA2 deficiency in generating hematologic disease. Inducible deletion of Myeloid Leukemia Cell 1 (Mcl1), a member of the Bcl2 family, in mice results in the loss of hematopoietic stem cells (HSCs) and progenitors, and in development of cytopenias. Design:RNA was isolated from EBV-immortalized B cells of 10 healthy controls and 13 MonoMAC patients with MDS and defined mutations in GATA2. microRNA expression profiles were generated using the Agilent high density human microRNA array. Array data were normalized to the data point of 75th percentile signal strength and to a set of spike-in and control probes. The differences between the means of experimental groups were analyzed by Mann-Whitney rank sum test. The miRs with significant p values (p≤ 0.05) and fold change (≥ 2-fold) in both normalization methods were selected for further analysis. TargetScan was utilized to predict the mRNA targets of aberrantly expressed miRs. miR targets were validated by functional studies in the Ly8 cell line. Results:Eight miRs were significantly differentially expressed (≥ 2-fold; p ≤ 0.05) as determined by microRNA microarray profiles. Six miRs showed increased expression in monoMAC cell lines compared to controls (miR-9, −181a-2–3p, −181c, −181c-3p, −486–3p, −582–5p) while two miRs showed significantly decreased expression (miR-223, −424–3p). Among the differentially expressed miRs that were validated by quantitative RT-PCR was miR-181c, which demonstrated a 2.2 fold increase in expression in MonoMAC cell lines (p = 0.013). Among the target transcripts potentially regulated by miR-181c, MCL1 expression was significantly decreased (2 fold; p = 0.018) in monoMAC cell lines in comparison to control cell lines. Transient transfection of miR-181c in Ly8 cells resulted in 40% decrease of MCL1 mRNA level, suggesting that miR-181c negatively regulates MCL1 in MonoMAC. Conclusions:These findings indicate that MonoMAC/GATA2 deficiency is associated with significantly decreased expression of MCL1 possibly through negative regulation involving miR-181c. Deletion of Mcl1 is known to cause apoptosis, loss of HSCs, and cytopenias in murine studies. Thus, down-regulation of MCL1 seen in MonoMAC/GATA2 deficiency may similarly favor unregulated apoptosis and the depletion of hematopoietic progenitors resulting in cytopenias, immunodeficiency, and risk of MDS/AML. Disclosures:No relevant conflicts of interest to declare.

Galenics: studies of the toxicity and distribution of sugar substitutes on Apis mellifera

The aim of this study was to find a substitute to sugar water in medicinal treatments of honey bee colonies with the same properties but without being ingested by bees or being toxic to them. Tylose MH, sorbitol and glycerol were tested for their attractiveness to Apis mellifera, their application ability, toxicity via individual application and distribution in small groups respectively a small colony. Neither of the substances proved attractive or toxic. All had good application ability except sorbitol. Glycerol showed the best distribution compared to tylose and sugar water (chi-square test, f = 1, P ≤ 0.01). So the distribution of glycerol within a colony was shown by macro-computed tomography: it was quick and even (comparing density values before and after treatment, Mann–Whitney rank sum test, P ≤ 0.001). Glycerol can be recommended as a substitute for sugar water in medicinal treatments. Yet, its use with active ingredients should be investigated for combinatory effects.

Characterization of Anorectal Functions and Overall Colonic Transit in Female and Male Patients with Dyssynergic Defecation

Purpose: In non-elderly healthy people, there are no significant differences between genders in anal sphincter resting pressure1 or colonic transit2. There is a paucity of information regarding males with dyssynergic defecation (DD). Gender differences have not previously been evaluated in patients with DD. Our purpose was to compare anal sphincter pressures, balloon expulsion weights, and overall colonic transit by gender in DD. Methods: Medical records of 407 patients with constipation in whom a diagnosis of DD was made, based on evaluation by a single gastroenterologist (MC) at a tertiary medical center, were reviewed. Data from a previously published cohort of 390 patients (1994 to 2011) was updated to include patients up to June 2012. DD was characterized by anorectal manometry (ARM), balloon expulsion test, and overall colonic transit using validated scintigraphy. Primary endpoints were maximum anal resting pressure (ARP), maximum anal squeeze pressure (ASP), added weight (BW) to allow balloon expulsion (data censored if patient unable to expel balloon despite addition of >470 g) and overall colonic transit (geometric center, GC) at 24h (GC24). Effects of gender on study endpoints were assessed by Mann-Whitney rank sum test. Our lab previously reported normal GC24 values in 209 controls3: median=2.3 (IQR 1.8, 2.9): males (n=72): 2.6 (2.1, 3.1); females (n=136): 2.1 (1.7, 2.6). Results: The DD patient cohort consisted of 66 males (M) and 341 females (F). Median (IQR) values of age and BMI were: 45.5y (30.0, 58.0) and 23.6 kg/m2 (21.5, 26.3) for M; 37.0y (26.0, 49.0) and 21.4 kg/m2 (19.1, 24.5) for F. Significant differences by gender were observed in ARP, ASP and GC24. GC24 was significantly slower in both genders compared to same gender controls. Data in table are median (IQR) values with corresponding n=size/group in DD patients. Conclusion: Patients with DD have slower overall colonic transit compared to gender matched controls. In DD patients, males have significantly higher resting and squeeze anal sphincter pressures, and females have slower overall colonic transit at 24 hours. These data suggest that interpretation of tests in patients with suspected DD should be based on data from same gender controls.Table: [1748]

Osteometabolic and Osteogenetic Pattern of Turkish Immigrants in Germany

The etiology of osteoporosis comprises environmental and genetic factors. This study investigated vitamin D deficiency and specific genetic alterations of bone metabolism in a group of 183 Turkish immigrants in Germany in comparison with 46 age and sex matched healthy German controls (females in both groups were pre-menopausal). Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Serum levels of osteologic parameters were determined after overnight fasting. Polymorphisms of the vitamin D receptor (VDR) and lactase genes were genotyped using genomic DNA from peripheral leukocytes. Statistical analysis comprised student's t-test, Mann-Whitney rank sum test, Chi-square analysis and Fisher's exact test. Severe 25-OH D₃ hypovitaminosis (83.1%) and elevated parathyroid hormone (82%) were common among immigrants. Osteoporosis but not osteopenia was more prevalent in immigrants. Among immigrants with osteoporosis, TRAP5b was elevated in 26.7%, and β-crosslaps in 13.3%. Only the FokI FF VDR-gene-polymorphism was significantly more prevalent among immigrants. In contrast, Ff-genotyped Turkish women exhibited significantly decreased BMD. Lactase polymorphisms were significantly more common among immigrants (84.2% vs. 30.4%) and the CC genotype was commonly associated with reduced BMD (41.6%) but rarely osteoporosis (8.4%). Vitamin D deficiency, secondary hyperparathyroidism and osteoporosis are common among Turkish immigrants in Germany. Thus, in this population osteologic parameters and BMD should be analyzed and deficiencies be treated. Specifically, the VDR gene polymorphism FokI Ff is of clinical value in identifying females at risk of osteoporosis. In contrast, LCT polymorphisms, though common, do not appear to be a risk factor.

Dose Accuracy of New Versus Used Novopen 4 Insulin Pens

To our knowledge, no studies have been performed testing dose accuracy in both new and used patient insulin injection pens. We hypothesized that the dose accuracy of used (>1 year) insulin pens to be less accurate than that of new insulin pens and investigated whether possible differences influence the treatment. This study compared the dosing accuracy of 11 new and 11 used (>1 year) Novopen(®) 4 pens (Novo Nordisk, Bagsvaerd, Denmark). Dosing accuracy differences between new and used pens were studied by weighing the volume of the dosage of 8 international units of insulin (IU) and 32 IU of 11 pens. Each measurement was repeated 15 times. Whether the pens complied with the International Organization for Standardization (ISO) limits of 10% for 8 IU and 5% for 32 IU was tested. The statistical analyses were performed using the Mann-Whitney rank sum test (within Sigmaplot version 12.0; Systat Software, Chicago, IL), and a P value of <0.05 was considered to be statistically significant. For the 8 IU dose, the mean delivered dose was 8.04 IU in new pens and 7.91 IU in used insulin pens. For the 32 IU dose, the mean delivered dose was 31.90 in new pens and 31.68 IU in used insulin pens. The difference in the median values between the two groups was statistically significant (P<0.001). Three individual doses in the 32 IU dose exceeded the ISO range in the lower range. The difference in mean variation coefficient between the two groups was also statistically significant (P<0.001). There was a significant difference between the accuracy of new versus used insulin pens. More studies with larger sample sizes are necessary to confirm our findings and further elucidate the relationship between age of insulin pens and dose accuracy.

Spatiotemporal analysis of normal and pathological human vocal fold vibrations

PurposeFor spatiotemporal analysis to become a relevant clinical tool, it must be applied to human vocal fold vibration. Receiver operating characteristic (ROC) analysis will help assess the ability of spatiotemporal parameters to detect pathological vibration. Materials and MethodsSpatiotemporal parameters of correlation length and entropy were extracted from high-speed videos of 124 subjects, 67 without vocal fold pathology and 57 with either vocal fold polyps or nodules. Mann-Whitney rank sum tests were performed to compare normal vocal fold vibrations to pathological vibrations, and ROC analysis was used to assess the diagnostic value of spatiotemporal analysis. ResultsA statistically significant difference was found between the normal and pathological groups in both correlation length (P < .001) and entropy (P < .001). The ROC analysis showed an area under the curve of 0.85 for correlation length, 0.87 for entropy, and 0.92 when the 2 parameters were combined. A statistically significant difference was not found between the nodules and polyps groups in either correlation length (P = .227) or entropy (P = .943). The ROC analysis showed an area under the curve of 0.63 for correlation length and 0.51 for entropy. ConclusionsAlthough they could not effectively distinguish vibration of vocal folds with nodules from those with polyps, the spatiotemporal parameters correlation length and entropy exhibit the ability to differentiate normal and pathological vocal fold vibration and may represent a diagnostic tool for objectively detecting abnormal vibration in the future, especially in neurological voice disorders and vocal folds without a visible lesion.

P2‐163: Sociodemographic characteristics and clinical factors of a sample of mild cognitive impairment

The pathophysiological process of Alzheimer's disease (AD) is thought to begin many years before the diagnosis of clinical dementia. The long preclinical phase of AD provides an opportunity for potential intervention with disease-modifying therapy. So, it is substantial to identify patients with Mild Cognitive Impairment (MCI) who have a greater risk to convert to AD. It is essential to identify the clinical demarcations between normal cognition and MCI and between MCI and dementia. The clinical judgment is important to make these distinctions.We conducted a prospective study to follow up individuals with MCI, with the objective of identifying demographic, clinical, neuropsychological, neuroimage and genetics factors possibly associated with the earlier diagnosis and conversion to AD. Here, we present our preliminary clinical results. Thirty seven amnestic MCI patients (73 ± 8 years old, 20 female, 17 male) were recruited from the Outpatients Clinic of Instituto Jenny de Andrade Faria de Atenção à Saúde do Idoso, Universidade Federal de Minas Gerais. They we submitted to clinical, neuropsychological, laboratory and neuroimagem examination.We identified and analyzed the socio-demographics and vascular risk factors and analyzed the cognitive and functional tests. Statistical analyses were performed with the SPSS 17.0, using the χ 2-test, Mann-Whitney rank sum test and the one-way ANOVA. Our patients have low education level (mean: 4.71 years). The MCI diagnosis was made based in neuropsychological evaluation. The diagnosis of major depression, diabetes mellitus, dyslipidemia and smoking were observed in a minor percentage of patients and 59.5% have hypertension. The perception of impairment was greater for families than for patients. In Table 1, we demonstrated the results of cognitive, functional, psychiatric and behavioral tests applied in geriatric evaluation. We observed a good score in Mini Mental Status Examination (24.42, S.D.: 2.89); no functional, behavioral or psychiatric significant changes. Even though, there is an important impairment in evocation on CERAD protocol (evocation: 3.17, S.D.:1.91) and a neighboring result in fluency test. Patients with MCI have less perception of their cognitive impairments. The most important change observed in clinical cognitive examination is the impairment of evocation. The basic and instrumental daily activities are preserved.

Using Technology-Assisted Instruction and Assessment to Reduce the Effect of Class Size on Student Outcomes in Undergraduate Mathematics Courses

The implementation of online texts, videos, homework, and tests has changed the process of instruction in introductory college mathematics courses. With this change, more of the students’ learning takes place outside of the traditional college classroom and in places such as tutoring centers and dorm rooms. A combination of chi-square tests—for independence with unordered categorical data—and Mann-Whitney two-sample rank-sum tests—for continuous data and ordered categorical data—were used to analyze student outcomes generated from College Algebra and Applied Calculus courses with class sizes ranging from 37 to 129, with common syllabi, homework, quizzes, and tests. These tests showed that medium classes (30–55 students) had little to no benefit over large classes (110–130 students) in student learning and student achievement, with large classes having small to medium positive-effect sizes over medium classes in the area of student satisfaction. The only area in which the small classes had a small positive effect was in the area of student engagement.

Delay in diagnosing Kawasaki disease. Identifying the root cause at the referral base of a regional children’s hospital

Methods Retrospective medical record review of a cohort of patients with KD over a 10 year period. All patients who met diagnostic criteria of KD seen in our Institution between January of 1999 and January of 2009 were included. The patient population was segregated into two groups according to the presence or absence of coronary aneurisms (CA + and CA -). Days from symptom onset to diagnosis and days from symptom onset to infusion were recorded. Demographic, clinical, echocardiographic and laboratory variables were recorded and described as well. Descriptive statistics and Mann-Whitney Rank Sum Test for comparison of groups were applied. A p ≤ 0.05 was considered significant.

The value of pre-ablation stimulated thyroglobulin in predicting distant metastasis of papillary thyroid cancer

Objective To investigate the value of pre-ablation stimulated Tg in predicting distant metastasis of papillary thyroid cancer (PTC).Methods The study included 231 patients with PTC who had undergone total thyroidectomy and subsequent 131I therapy.Patients were divided into two groups as M1(38 cases,15 males,23 females,average age (43.9 ± 16.3) y) and M0(193 cases,60 males,133 females,average age (42.4 ± 11.4) y) according to the presence and absence of distant metastases,respectively.T-test and x2 test were used to evaluate the statistical differences between the two groups.The Tg value between M0 and M1 was compared by Mann-Whitney rank-sum test.The ROC curves and critical point (DCP) were analyzed to evaluate the predictive value of stimulated Tg.Results There was no significant difference between the two groups in age (t=-0.675,P=0.50) and gender (x2=1.02,P=0.31).Pre-ablation stimulated Tg was significantly different between the two groups (the Mann-Whitney rank-sum test:U=787.5,P＜0.001).Area under the ROC curve for Tg levels was 0.893 (95％ CI:0.863-0.962).The cut-off value of DCP of Tg was 52.75 μg/L with a sensitivity of 78.90％ and specificity of 91.70％.Conclusion Stimulated Tg may be a useful diagnostic tumor marker for predicting distant metastases of PTC before the first 131I ablation therapy. Key words: Thyroid neoplasms; Carcinoma,papillary; Thyroglobulin; Iodine radioisotopes